Over 1 million medicines (new child-friendly TB meds) rolled out in 3 years
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(CNS): More and more children around the world are now benefitting from
fixed dose combination (FDC) of child-friendly medicines to treat
drug-sensitive TB, thanks to the untiring efforts of TB Alliance (Global Alliance for TB Drug
Development) and its partners including World Health Organization (WHO), for
making these drugs go from development to delivery stage.
TB Alliance proudly announced at the first international conference on
global health security, taking place in Sydney, Australia, that over 1
million treatment courses of this medication have been ordered by 93 countries
(which carry 75% of the estimated childhood TB burden globally) in the 3 years
since their introduction in 2016.
India too is one such country where these new formulations are now being used to treat all children with drug sensitive TB under its National TB Control Programme. "Child-friendly anti-TB formulations have resulted into better acceptance and helped the programme [Revised National Tuberculosis Control Programme - RNTCP] scale up treatment" said head of RNTCP, Dr KS Sachdeva, who is the Deputy Director General at Central TB Division, Ministry of Health and Family Welfare, Government of India.
"Vietnam began treating children with TB with first-ever
child-friendly TB medicines from January 2018 onwards. So far, nearly 2000
children with TB have been treated using new child-friendly TB medicines. Now,
child-friendly TB medicines are made available for all children who are
diagnosed with drug-susceptible TB in the country" said Dr Nguyen Viet
Nhung, head of national TB programme in Vietnam; Director of National Lung
Hospital, Hanoi; and Honorary Associate Professor, University of Sydney.
"98% of the ordered treatment courses [of child-friendly TB medicines]
were procured through the Stop
TB Partnership's Global Drug Facility, with funds provided by USAID, Global
Affairs Canada, the Global Fund [Global Fund to fight AIDS, TB and Malaria] as
well as domestic budgets," informed Dr Lucica Ditiu, Executive Director
of Stop TB Partnership.
Million doses of new therapy rolled-out in
42+ months
It was on 2nd December, 2015 that the world's first appropriate,
child-friendly fixed dose combination (FDC) medicines to treat children
suffering from drug-sensitive TB were launched. For the first time, there was
appropriate treatment for the children with TB, with a formulation of drug that
was easy for kids to take, that tasted good and that made the disease much
easier to treat. Kenya was the first country in the world to roll out these
products nationally in October 2106. Since then the number of countries opting
for them has risen steadily- from 3 countries and 16193 treatment courses in
2016 to 93 countries and 1022,922 courses by end of 1st quarter of 2019.
TB affects over a million children every year
TB affects more than 1 million children and kills 234,000 of them every
year (more than 600 deaths every day), mostly in low and middle income
countries. Another 67 million children are infected with the latent form of the
disease. Also, more than 50% of the children, who develop active TB each year,
are either undiagnosed or incorrectly diagnosed by doctors. Those who were
diagnosed had to rely on 6 months of foul-tasting, improperly formulated
medicines to fight the disease. Yet, children with TB had long remained a low
priority for stakeholders in both the TB and global health areas.
Eventually in 2013, TB Alliance, in partnership with WHO, marshalled partners
around the world to respond to this dire situation, engaging the pharmaceutical
industry to develop better medicines for children with TB. With a major
investment from Unitaid, it launched STEP-TB (Speeding Treatments to End
Paediatric Tuberculosis) initiative to improve treatment for children with TB.
Their efforts bore fruit and the world's first appropriate, child-friendly
fixed dose combination (FDC) medicines to treat children suffering from
drug-sensitive TB were announced in December 2015 and children around the world
began to receive better TB medicines in the right doses. Macleods Pharmaceuticals
was the first manufacturer to do the scale-up and formulation work necessary to
bring these new products to market.
FDCs are when several drugs are combined together with a specific dosage of
each drug included in one tablet. They are easier for children to take and have
improved treatment and survival rates. Previously, care providers had to crush
or chop bitter-tasting adult pills or combine incorrectly dosed formulations to
approximate the 'right' daily dose for children. This not only made the 6 month
treatment journey difficult for children and their families, contributing to
difficulties with adherence, but improper dosing also led to treatment failure
and death from the disease. The FDC consists of just one tablet in the correct
child appropriate dosage. Moreover, these pills are easier for children to take
as they dissolve in water and are fruit flavoured.
"These child-friendly FDCs are ensuring that children receive the right
doses of medicines, increase adherence and treatment outcomes, ease the burden
on families and save more lives," said Dr Tereza Kasaeva, Director of
the WHO Global TB Programme.
Lessons learnt
But the journey has not been easy. In an exclusive interview with CNS, Sandeep
Juneja who is the Senior Vice President for Market Access at TB Alliance
said that "Countries had unique barriers that informed their decisions
around adoption and procurement of the child-friendly FDCs, all of which had to
be identified and considered in offering support or engaging to drive adoption
and use. Moreover, funding and procurement cycles are not always aligned. So
timely and early sensitization of drug availability to relevant stakeholders
can help them plan procurement of new drugs efficiently and effectively.
However, we now have good visibility and experience of these which will be
useful in future market introductions."
The way forward
From 3 countries and 16193 treatment courses in 2016 to 93 countries
and 1022,922 courses by end of 1st quarter of 2019, the STEP-TB project has
proved that the development and uptake of improved health products is
achievable. Agrees Juneja: "Strong value addition is important for robust
uptake of a drug or regimen. The participation of middle income, high burden
countries is imperative to create adequate scale with lower volume products.
Collaborations with key stakeholders can help drive policy change, overcome
bottlenecks and drive uptake of innovative, life-saving medicines, as happened
in the case of child friendly FDC to treat drug sensitive TB in children."
As it is, TB is tough on kids. The least that we can do is to ensure that no
child should have to struggle with inferior medicines or die of TB. Together we
can bring childhood TB from the shadows. Action starts with us.
Shobha Shukla, CNS
(Shobha Shukla is CNS Managing Editor. Follow her on Twitter @shobha1shukla or visit www.citizen-news.org)
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